Online Learning Series
Right Care for Populations
Integrating Pathway Hub:
A Prime Contractor Model
Dr. Alan Nye
Director Pennine MSK Partnership Ltd
January 2014
Copyright 2011 Right Care
What’s the Problem?
System of Care
• Micro-commissioning complex care
pathways
o Perverse incentives – PbR
o KPIs process driven not
population level improvement or
patient experience
o No effective performance
management of care
• Lack of true clinical leadership
• Separation from clinical accountability
from financial responsibility
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Integrating Hub Model
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Oldham
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Pennine MSK
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• Primary Care based organisation
commissioned by NHS Oldham to provide
non admitted care in rheumatology,
orthopaedics and chronic pain
• Consultant led – provide 97% rheumatology
and take patients to point of listing in
Orthopaedics
• From May 2011 control £23m programme
budget for MSK using prime vendor model
• Psychological medicine for chronic pain
• 9,500 new referrals a year
• Deliver traditional hospital based services
from community – biologics and infusions
• GP and Registrar training
Programme Budget Commissioning
Different from standard care
• Commission for defined population
with a defined budget
• Commissioners have population
quality based KPIs
• Have prime contractor which
shares responsibility for care coordination and performance
management
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NHS Oldham Programme Budget’s
MSK - £23m - Pennine MSK 1st May 2011
Primary Care
• Local enhanced services
Community Care
• Pennine MSK
• Physiotherapy, podiatry
Secondary Care
• All activity included
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Delivering Integration
• Commissioner will focus on clinical
outcomes rather than process metric
• Patients at the centre of our
redesign
• Work with third sector
• Use self management and self
referral were clinically appropriate
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Pennine MSK Impact
Reducing per capita cost whilst maintaining quality
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Pennine MSK Impact
Reducing per capita cost whilst maintaining quality
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Building on success…
• In 2013 Oldham has developed
Programme Budget Commissioning for a
Mental Health programme
• Over the coming year the CCG will
develop this approach over a whole range
of programmes.
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Online Learning Series
Right Care for Populations
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